TNM residual tumor classification revisited

Authors

  • Christian Wittekind M.D.,

    Corresponding author
    1. Institute of Pathology, University Clinic of Leipzig, Leipzig, Germany; International Union Against Cancer TNM Prognostic Factors Project Committee
    • Institute of Pathology, University Clinic of Leipzig. Liebigstraße 26, D-04103 Leipzig, Germany
    Search for more papers by this author
    • Fax: (011) 493419715009

  • Carolyn C. Compton M.D., Ph.D.,

    1. Department of Pathology, McGill University, Montreal, Quebec, Canada
    Search for more papers by this author
  • Frederick L. Greene M.D.,

    1. Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina; American Joint Committee on Cancer TNM Process Subcommittee
    Search for more papers by this author
  • Leslie H. Sobin M.D.

    1. Division of Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington DC; International Union Against Cancer TNM Prognostic Factors Project Committee
    Search for more papers by this author

Abstract

BACKGROUND

For cancer patients, prognosis is strongly influenced by the completeness of tumor removal at the time of cancer-directed surgery or disease remission after nonsurgical treatment with curative intent. These parameters define the relative success of definitive treatment and can be codified by an additional subclassification within the TNM system, the residual tumor (R) classification. Despite the importance of residual tumor status in designing clinical management after treatment, misinterpretation and inconsistent application of the R classification frequently occur that diminish or abrogate its clinical utility.

METHODS

An analysis of the relevant literature regarding the use and prognostic importance of the R classification was undertaken.

RESULTS

In the current study, the prognostic importance of the R classification for different kinds of tumors is discussed. Problems that arise in using the R classification are described. Special issues regarding the use of the R classification are addressed.

CONCLUSIONS

The R classification is a strong indicator of prognosis and facilitates the comparison of treatment results if applied in a consistent manner. Uniform use and interpretation of this classification is essential for the standardization of posttreatment data collection. Cancer 2002;94:2511–9. © 2002 American Cancer Society.

DOI 10.1002/cncr.10492

Ancillary